Provider Demographics
NPI:1588662118
Name:GRAY, TIMOTHY ROSS (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ROSS
Last Name:GRAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23625 140TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-3805
Mailing Address - Country:US
Mailing Address - Phone:253-854-9890
Mailing Address - Fax:
Practice Address - Street 1:13106 SE 240TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-9210
Practice Address - Country:US
Practice Address - Phone:253-854-9890
Practice Address - Fax:253-852-0585
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000062531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice